It is fascinating to observe and contrast the genetically determined structural differences in noses of various ethnicities, and what the perceived images of the “ideal nose” is amongst diverse cultures. Public perception of the perfect nose is ever changing as a result of popular media. As Australia becomes an increasingly multicultural society, a greater appreciation and understanding of the different surgical techniques required to achieve a desired nose in both “Caucasian” and “Asian” noses is essential, and there are considerable differences!

In most western nations, including Australia, a large proportion of Caucasian rhinoplasty patients desire a general reduction and refinement of their nose. The problem is often a “Big Nose”. Although each nose needs to be carefully assessed and a surgical plan for improvement be individually devised, a common surgical approach to the Caucasian nose would involve lowering and narrowing of the “hump” and narrowing and refinement of a wide tip. As in all rhinoplasties, breathing and functional issues such as a bent septum should be addressed at the same time if present. Patients from Asian backgrounds who are seeking rhinoplasties require a conceptually opposite approach to the traditional Caucasian rhinoplasty.

Genetically speaking, Asian noses possess a lower nasal dorsum, less tip (forward) projection, and wider alar (nostril) bases, although exceptions to this can be seen (often on covers of magazines!). In general, I do not advocate an “obvious western nose” in an Asian patient; however, a conservative augmentation of a flat Asian nose can bring out a very pleasing improvement to the overall aesthetics of the face, whilst retaining ethnicity. Augmentation of the nose can be performed autologously (using your own cartilage) or using implants (such as silicone) or, as is often required, a combination of both. The risk with using artificial implants is that of infection, and therefore implant longevity.

This risk can be reduced significantly by utilising your own tissue in certain critical parts of the nose, such as the tip. There are of course noses that don’t fall into the shape of the categories described above. Every nose is unique and every rhinoplasty requires an individualised approach. So, let’s ignore the popular media for a moment as it continues in its search to define the universally perfect nose. Instead, let’s consider what may be a nice nose for the individual, something which will suit and enhance other aspects of their face. At the same time, we must be ever aware of the limits of plastic surgery, and surgical goals and desired outcomes should remain realistic and achievable.